Patient Forms

  • Patient Intake Form

    Please complete the patient intake form before your scheduled appointment. New and existing patients must meet the updated intake form if you haven’t already. Click the link below to complete.

    Patient Intake Form

  • Medical Records Release

    To have records sent TO our office, complete this form by clicking the link.

    Record Request

  • MEDICAL RECORDS RELEASE

    To have records sent TO our office, complete this form by clicking the link.

    Medical Release Form

  • Semaglutide Consent

    Consent to treat. This form is only for those who have completed medical evaluation and have been cleared for treatment.

    Semaglutide Consent

  • PRP Consent

    Platelet Rich Plasma Therapy Consent

  • Pheonix Thera-Lase

    Pheonix Thera-Lase System Consent

  • Pain Scale Form

    Use the following form to track your improvement. The doctor will implement your responses into the treatment plan.

    Pain Scale Form